Social Worker (LSW). 2. Current BCLS certificate preferred. 3. Knowledge of Milliman Criteria and InterQual Criteria...
Required Experience using InterQual or Milliman Preferred Licenses and Certifications Current unrestricted registered nurse (RN...
. Current BCLS (AHA) certificate, preferred. 5. Knowledge of Milliman Criteria and InterQual Criteria preferred. 6. Experience...
proactively to inform and alert upper management of anticipated delays. Reviews clinical against Milliman criteria to help...
and drug policies, medical protocols, National Comprehensive Cancer Network, Milliman Care Guidelines, Drugdex...
Knowledge of terminology CPT codes and ICD 10 Bilingual preferred Knowledge of InterQual or Milliman Care Guidelines preferred...
standards of care Awareness of UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare...
, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary. Collaborates with clinical teams...
, clinical standards of care, NCQA requirements, CMS guidelines, Milliman guidelines, InterQual guidelines, Medicaid/Medicare...
in an acute care setting preferred. Working knowledge of InterQual IS-SI Milliman and Robertson Managed Care guidelines, Erickson...